Background: This study aims to investigate the efficacy of tissue Doppler
echocardiography for the diagnosis of right ventricular dysfunction and
for the evaluation of the response to pulmonary valve replacement.

Methods: Between December 2008 and December 2010, a total of 15 patients
(8 males, 7 females; mean age: 14.5±4.5 years; range, 7 to 22 years) with
pulmonary valve insufficiency in the follow-up of total correction of
tetralogy of Fallot who underwent pulmonary valve replacement were
included in the study. Echocardiographic imaging was performed before
and one, three, and six months after replacement. Using pulse wave Doppler,
early diastolic E and late diastolic A waves were measured in the flow
velocity curve of tricuspid valve. Tissue Doppler measurements were made
from the basal segment of right ventricular free wall and interventricular
septum. S, e, and a myocardial velocities, isometric contraction time,
isovolumetric relaxation time and ejection time were measured. Myocardial
performance index was calculated for each patient.

Results: In pre-pulmonary valve replacement phase, s, e, a velocities and
ejection time were lower in the interventricular septum compared to the
basal segment of right ventricular free wall, while isometric contraction
time, isovolumetric relaxation time and myocardial performance index
values were higher. In the first post-replacement month, there was a
significant decrease in the s value of interventricular septum, compared
to pre-pulmonary valve replacement period; isometric contraction time
decreased and myocardial performance index increased in the first postpulmonary
valve replacement month in the free wall of right ventricle, while
isovolumetric relaxation time decreased in the postoperative third month,
and s velocity, isometric contraction time and myocardial performance index
increased in the postoperative sixth month. Pre-pulmonary valve replacement
tissue Doppler values at the septum showed that myocardial systolic and
diastolic dysfunction developed earlier than the basal segment of right
ventricular free wall. This result showed that right ventricular recovery was
not complete in the sixth post-pulmonary valve replacement month.

Conclusion: Tissue Doppler can show right ventricular dysfunction
before replacement, but it may be insufficient to visualize right
ventricular recovery until six months after treatment.

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